Predictors Of Patient Satisfaction Research Articles

The effectiveness of structured interdisciplinary collaboration for adult home hospice patients on patient satisfaction and hospital admissions and re-admission: a systematic review protocol

The effectiveness of structured interdisciplinary collaboration for adult home hospice patients on patient satisfaction and hospital admissions and re-admission: a systematic review protocol

Baseline factors predictive of patient satisfaction with sacral neuromodulation for idiopathic fecal incontinence.

Sacral neuromodulation (SNM) is an established treatment for fecal incontinence (FI). A recent study from our group found that the relationship between patient satisfaction and clinical outcome is complex and does not match the traditional used success criteria. Therefore, the ability to predict patient satisfaction must be given priority. The aim of the present study is to identify baseline factors predictive of patient satisfaction, with SNM, for idiopathic FI. We analyzed data from patients treated with SNM for idiopathic FI in Aarhus, Denmark, and Maastricht, The Netherlands. A questionnaire considering self-reported satisfaction was mailed to these patients and compared to baseline characteristics. Logistic regression was used to determine the predictive value of baseline demographic and diagnostic variables. In total, 131 patients were included in the analysis. Patient satisfaction with the current treatment result was reported in 75 patients. Fifty-six patients were dissatisfied with SNM treatment, after median 46 months (range 11-122) with permanent implantation. Pudendal nerve terminal motor latency (PNTML) was the solely identified predictor for long-term patient satisfaction. A subgroup univariate-logistic regression analysis showed that PNTML ≤ 2.3 ms at the side of lead implantation was a statistically significant predictor for patient satisfaction (odds ratio (OR) 2.3, 95% confidence interval (CI) 1.01-5.24, p = 0.048). Baseline PNTML measurement may be predictive of long-term satisfaction with SNM therapy for idiopathic FI. Further studies are needed to confirm this result.

MP3-11 DETERMINANTS OF PATIENT SATISFACTION AFTER ANTERIOR URETHROPLASTY

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery II1 Apr 2014MP3-11 DETERMINANTS OF PATIENT SATISFACTION AFTER ANTERIOR URETHROPLASTY Gareth Warren, Bradley Erickson, Laura Bertrand, Sean Elliott, Jeremy Myers, Christopher McClung, Bryan Voelzke, and Trauma and Urologic Reconstruction Network of Surgeons Gareth WarrenGareth Warren More articles by this author , Bradley EricksonBradley Erickson More articles by this author , Laura BertrandLaura Bertrand More articles by this author , Sean ElliottSean Elliott More articles by this author , Jeremy MyersJeremy Myers More articles by this author , Christopher McClungChristopher McClung More articles by this author , Bryan VoelzkeBryan Voelzke More articles by this author , and Trauma and Urologic Reconstruction Network of Surgeons More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.190AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patient reported surgical outcomes, including overall satisfaction, will become increasingly important to surgeons with our changing healthcare system. The purpose of this study was to analyze what factors, besides traditional surgical success, are predictors of patient satisfaction after anterior urethroplasty. METHODS Between June 2010 and July 2013, men with anterior urethral stricture disease were enrolled in a prospective, multi-institutional, urethroplasty outcomes study. Postoperative satisfaction was assessed by asking men on a five-point likert scale, “Were you satisfied with your surgical procedure?”. Potential predictor variables analyzed using uni- and multivariate techniques included standard patient and stricture characteristics, questionnaire data (International Prostate Symptom Score (IPSS), Male Sexual Health Questionnaire - Ejaculation (MSHQ - Ej), Sexual Health Inventory for Men (SHIM), and other sexual function questions), uroflowmetry, and stricture recurrence (determined by cystoscopy). Postoperative testing occurred at 3 and 12 months. RESULTS There were 131 patients that completed pre/post op satisfaction questionnaires, of which 114 (87%) were either very satisfied or satisfied after their surgery and 17 (13%) were neither satisfied/unsatisfied or unsatisfied/very unsatisfied at a median follow-up time of 10 months. Univariate predictors for patient satisfaction included: prior urethroplasty (No (93%) vs. Yes (69%); p = 0.0008), stricture location (bulbar (92%) vs. penile (72%); p = 0.024), altered intercourse frequency (versus pre-op) (No (94%) vs. Yes (69%); p = 0.0004) and new onset penile curvature (No (90%) vs. Yes (71%); p = 0.02). Recurrence was noted in 11 (8%) men but was not predictive of satisfaction (p=0.13). Changes in postoperative voiding symptoms, quality of life (QOL) and uroflowmetry were also associated with postoperative satisfaction (Table). On multivariable analysis, initial urethroplasty (versus repeat; OR 20.8), stable intercourse frequency (versus decreased; OR 8.9), and improved post-op urinary QOL (OR 2.3) were independent satisfaction predictors. CONCLUSIONS Patient satisfaction was high after urethral reconstruction. Dissatisfaction was associated with lower improvements on voiding questionnaires, lower patient reported QOL improvements, lower post-op urinary flow rates, negative sexual side-effects, and in patients undergoing repeat urethroplasty. Table. Patient Reported Outcomes After Urethral Reconstruction By Post-operative Satisfaction. Unsatisfied Mean (SD) Satisfied Mean (SD) p-value Post-op IPSS Total 9.44 (8.51) 1.13 (4.50) 0.0371 Δ IPSS Total 7.06 (11.16) 12.12 (10.73) 0.084 Δ MSHQ (Ej) Total -0.75 (6.70) -2.56 (4.57) 0.3127 Δ SHIM 0.82 (7.67) 0.30 (5.11) 0.7199 Δ CLSS Total 4.94 (6.31) 8.89 (6.48) 0.0266 Δ CLSS QOL 1.13 (1.36) 3.27 (2.10) 0.0002 Post-op Max Flow Rate (mL/sec) 17.4 (6.05) 22.94 (12.46) 0.0081 Δ Max Flow Rate 8.51 (6.36) 14.32 (13.85) 0.0647 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e38 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Gareth Warren More articles by this author Bradley Erickson More articles by this author Laura Bertrand More articles by this author Sean Elliott More articles by this author Jeremy Myers More articles by this author Christopher McClung More articles by this author Bryan Voelzke More articles by this author Trauma and Urologic Reconstruction Network of Surgeons More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Editorial: Predicting surgical satisfaction using artificial neural networks

In this issue of the Journal of Neurosurgery: Spine, the clinical article titled “Use of artificial neural networks to predict surgical satisfaction in patients with lumbar spinal canal stenosis” by Azimi and colleagues1 represents the first application of an artificial neural network (ANN) in predicting outcomes from spinal surgery. Although ANNs have been used in the biomechanical assessments of spine disease, to date the literature lacks any examples of the clinical applications of ANNs in patients with spine disease. The authors undertook this initiative by identifying 168 patients who had undergone surgery for lumbar stenosis and who had completed a series of preoperative grading instruments. Along with age, sex, and symptom duration, scores on these instruments were collectively taken as the inputs for the ANN. The network was trained on half of the patients by pairing the inputs with known outputs. When a novel cohort of patients was then used to test the model, it statistically outperformed a standard logistic regression (LR) model in terms of accuracy in predicting surgical satisfaction. Notably, the authors incorporated only preoperative data points in an effort to predict long-term outcome. One could reasonably expect that the most important factors in predicting this include biomechanical and surgical factors such as sagittal balance, the number of levels decompressed, and whether or not the interspinous ligaments are preserved during decompression, just to name a few. Accurate prediction of longer-term outcomes would probably need such variables incorporated. It would not only be simple to model an end point such as whether or not a patient receives a spinal fusion, but this would have practical implications if such a model were ever to be used in clinical practice. One of the popular criticisms of ANN modeling is that the variables exist as a “black box,” with the exact relationships and interaction between them remaining somewhat abstract. Although this is true, what can still be gleaned easily from the model is which of the variables is most salient in predicting outcome. A simple visual representation of the model in the authors’ Fig. 3 readily reveals that the stenosis ratio has the greatest impact in predicting patient satisfaction. We remain quite a distance from seeing the use of ANNs in practice. To date there are well under a dozen examples of ANN models applied to neurosurgical diseases. The few examples that exist, however, illustrate the power of this form of modeling over traditional linear models, and also over clinical intuition alone. To date ANNs have been shown to outperform LR models at predicting 1-year survival in patients with brain metastases,4 have been shown to be more accurate than LR models at predicting in-hospital survival in patients with traumatic brain injury,6 more accurate than either LR models or clinicians in predicting in-hospital survival from traumatic brain injury,5 more accurate than LR models in predicting survival from intracerebral hemorrhage,3 and more accurate at predicting which patients with subarachnoid hemorrhage are likely to suffer from cerebral vasospasm.2 That the demonstrated accomplishments of ANNs in neurosurgery can be listed so briefly hints at their unexplored potential. It is worth emphasizing that the authors used a commercially available software package to generate their ANN model. This nicely highlights the ease with which such models can be developed. As clinical decision making becomes increasingly complex, clinical decision support tools will perhaps play an increasingly useful role in clinical practice. At the present time, however, such clinical informatics remain widely underdeveloped and underutilized, especially in the realm of neurosurgical diseases. To this end, the authors have contributed a simple proof of concept of the application of ANNs to neurosurgical decision making. (http://thejns.org/doi/abs/10.3171/2013.10.SPINE13851)

Predictors of Patient Satisfaction in Three Tiers of Health Care Facilities of North India

Background: Satisfaction with quality of health care provision can be conceptualized as a degree of congruency between patient expectation and his perception of services and care received. Aims and objectives: This paper examines the level of satisfaction among patients attending OPD (Outpatient Department) in public health facilities in a city in Northern part of India. Methodology: The study used a cross-sectional sample survey design, wherein a total of 942 study subjects were exit interviewed. An eighty item scale was developed and validated using Delphi technique which covers six major domains of patient satisfaction. It was pilot tested in twenty subjects for development of final tool. Each item was dichotomized as “not satisfied” and “satisfied”. The composite score of each item was later computed and coded as “below average satisfaction” if it was below 0.5 and “above average satisfaction” if it was above 0.5. Binary logistic regression was performed to identify potential predictors of patient satisfaction. Results: Out of 942 study subjects, 728 (77.3%) were satisfied with the various dimensions of service provision at the health care facilities. Logistic regression model revealed that the predictors of patient satisfaction were accessibility to health facility (Odds ratio=6.6), physician care (Odds ratio=4.2), management (Odds ratio=2.9) and physical environment (Odds ratio=2.1). Display of signage’s and staff behaviour did not predict patient satisfaction. Patients attending higher level health care facilities like district hospital were more satisfied (Odds ratio=123.3) as compared to those attending community health centres (Odds ratio=26.0), polyclinic (Odds ratio=12.5) and dispensaries. The respondents in younger age group (10-19 years) were more satisfied as compared to those in age group 19-60 years (Odds ratio=0.79) and 60 years and above (Odds ratio=0.64). Similarly, literate individuals were less satisfied (Odds ratio=0.2) as compared to their counterparts. Conclusion: To conclude, there was an overall good level of satisfaction with OPD. The policy makers should focus on correlates of satisfaction namely, accessibility to health facility, physician care, physical environment and management of health care facility.

Predictors of Patient Satisfaction after Sling Surgery for Urinary Stress Incontinence

Predictors of Patient Satisfaction after Sling Surgery for Urinary Stress Incontinence

Which Outpatient Wait-Time Measures Are Related to Patient Satisfaction?

Long waits for appointments decrease patient satisfaction. Administrative wait-time measures are used by managers, but relationships between these measures and satisfaction have not been studied. Data from the Veterans Health Administration are used to examine the relationship between wait times and satisfaction. Outcome measures include patient-reported satisfaction and timely appointment access. Capacity and retrospective and prospective time stamp measures are calculated separately for new and returning patients. The time stamp measures consist of the date when the appointment was created in the scheduling system (create date [CD]) or the date the appointment was desired as the start date for wait-time computation. Logistic regression models predict patient satisfaction using these measures. The new-patient capacity, new-patient time stamp measures using CD, and the returning-patient desired-date prospective measure were significantly associated with patient satisfaction. Standard practices can be improved by targeting wait-time measures to patient subpopulations.

Determining the quality and effectiveness of surgical spine care: patient satisfaction is not a valid proxy

Background contextGiven the unsustainable costs of the US health-care system, health-care purchasers, payers, and hospital systems are adopting the concept of value-based purchasing by shifting care away from low-quality providers or hospitals. Legislation now allows public reporting of these quality rankings. True measures of quality, such as surgical morbidity and validated questionnaires of effectiveness, are burdensome and costly to collect. Hence, patients' satisfaction with care has emerged as a commonly used metric as a proxy for quality because of its feasibility of collection. However, patient satisfaction metrics have yet to be validated as a measure of overall quality of surgical spine care. PurposeWe set out to determine whether patient satisfaction is a valid measure of safety and effectiveness of care in a prospective longitudinal spine registry. Study designProspective longitudinal cohort study. Patient populationAll patients undergoing elective spine surgery for degenerative conditions over a 6-month period at a single medical center. Outcome measuresPatient-reported outcome instruments (numeric rating scale [NRS], Oswestry disability index [ODI], neck disability index [NDI], short-form 12-item survey [SF-12], Euro-Qol-5D [EQ-5D], Zung depression scale, and Modified Somatic Perception Questionnaire [MSPQ] anxiety scale), return to work, patient satisfaction with outcome, and patient satisfaction with provider care. MethodsAll patients undergoing elective spine surgery for degenerative conditions over a 6-month period at a single medical center were enrolled into a prospective longitudinal registry. Data collected on all patients included demographics, disease characteristics, treatment variables, readmissions/reoperations, and all 90-day surgical morbidity. Patient-reported outcome instruments (NRS, ODI, NDI, SF-12, EQ-5D, Zung depression scale, and MSPQ anxiety scale), return to work, patient satisfaction with outcome, and patient satisfaction with provider care were recorded at baseline and 3 months after treatment. Receiver-operating characteristic (ROC) curve analysis was performed to determine whether extent of improvement in quality of life (SF-12 physical component summary [PCS]) and disability (ODI/NDI) accurately predicted patient satisfaction versus dissatisfaction. Standard interpretation of area under the curve (AUC) was used: less than 0.7, poor; 0.7 to 0.8, fair; and greater than 0.8, good accuracy. Multivariate logistic regression analysis was performed to determine if surgical morbidity (quality) or improvement in disability and quality of life (effectiveness of care) were independently associated with patient satisfaction. ResultsFour hundred twenty-two (84%) patients completed all questionnaires 3 months after surgery during the reviewed time period (mean age 55±14 years). Lumbar surgery was performed in 287 (68%) and cervical surgery in 135 (32%) patients. There were 51 (12.1%) 90-day complications, including 21 (5.0%) readmissions and 12 (2.8%) return to operating room. Three hundred fifty-eight (84.8%) patients were satisfied with provider care and 288 (68.2%) with their outcome. Satisfaction with provider care: In ROC analyses, extent of improvement in quality of life (SF-12) and disability (ODI/NDI) differentiated satisfaction versus dissatisfaction with care with very poor accuracy (AUC 0.49–0.69). In regression analysis, 3-month morbidity (odds ratio [95% confidence interval]: 1.45 [0.79–2.66]), readmission (0.66 [0.24–1.80]), improvement in quality of life (SF-12 PCS), or improvement in general health (health transition index) were not associated with satisfaction with care. Satisfaction with outcome: In ROC analyses, improvement in quality of life (SF-12) and disability (ODI/NDI) failed to differentiate satisfaction with good accuracy (AUC 0.76). Neither 90-day morbidity (1.05 [0.46–2.34]) nor 90-day readmission (0.27 [0.04–2.04]) was associated with satisfaction with outcome in regression analysis. ConclusionsPatient satisfaction is not a valid measure of overall quality or effectiveness of surgical spine care. Patient satisfaction metrics likely represent the patient's subjective contentment with health-care service, a distinct aspect of care. Satisfaction metrics are important patient-centered measures of health-care service but should not be used as a proxy for overall quality, safety, or effectiveness of surgical spine care.

Outcome after Metatarsal Osteotomy for Hallux Valgus: A Study of Postoperative Foot Function Using Revised Foot Function Index Short Form

The aim of the present study was to evaluate patients' perception of their functional outcome at 6 and 12 months after surgical correction for hallux valgus using the Foot Function Index Revised short form. A total of 59 patients underwent 68 osseous and soft tissue procedures for the correction of hallux valgus deformity from January 2009 through December 2010. The outcome analysis was based on the validated patient questionnaire, the Foot Function Index Revised. The preoperative data were collected on the day of the patient's surgery using the Foot Function Index Revised short-form questionnaire. The postoperative data were collected at 6 and 12 months after the patient's initial surgical date using the same validated questionnaire. The cumulative Foot Function Index Revised score and the scores in each subscale demonstrated statistically significant data at both 6 and 12 months of follow-up. On average, the Foot Function Index Revised scores had improved by 39% at 6 months and 50% at 12 months. The improvement in all scores indicated an improvement in health-related foot function after hallux valgus surgery, evidencing effective surgical intervention. Expectations are the best predictors of patient satisfaction, and the present study has provided statistically significant data to allow physicians to establish realistic outcomes after surgical correction for hallux valgus deformity.

Commentary: Patient satisfaction in spinal surgery: should we be addressing customer service or health improvement?

COMMENTARY ON Adogwa O, Parker SL, Shau DN, et al. Preoperative Zung depression scale predicts patient satisfaction independent of extent of improvement after revision lumbar surgery. Spine J 2013;13:501–6 ( in this issue ).

Predicting patient satisfaction using the Oxford knee score: where do we draw the line?

The aim of this study was to identify threshold values in the pre- and post-operative Oxford knee score (OKS), and change in the score for differing levels of patient satisfaction with their total knee replacement (TKR). We prospectively collected pre-operative and 1-year post-operative OKS for 2392 patients undergoing a TKR. Patient satisfaction was categorically assessed, according to whether they were: very satisfied, satisfied, neutral, and unsatisfied. Receiver operating characteristic curve analysis was used to identify thresholds in the OKS score that identified each level of patient satisfaction. The post-operative OKS was the most accurate predictor of the level of patient satisfaction (area under the curve=0.86). Very satisfied patients had a threshold value in the post-operative OKS of ≥36, which decreased to ≥27 points for satisfied patients, and further still to ≤25 for unsatisfied patients. The threshold values, we have identified for the different levels of satisfaction using the post-operative OKS, which is the most accurate predictor, can be used to predict level of patient satisfaction and give quantification of the OKS.

Predictors of patient satisfaction with anaesthesia and surgery care

Previous research has shown that most patients are satisfied with their anaesthetic care. For those who are not the causes may be multifactorial including dissatisfaction with surgical outcomes. We aimed to identify whether quality of recovery after anaesthesia and surgery measured in multiple domains affects patient satisfaction. Sub-group analysis of previously published observational cohort study of quality of recovery after surgery (using the Postoperative Quality of Recovery Scale) was used to identify predictors of incomplete satisfaction 3 days after surgery. Multicentre perioperative surgery. Patients ≥6 years old, undergoing a variety of operation types and all receiving general anaesthesia. Of 701 patients, 573 completed the satisfaction question on day 3. Satisfaction was rated by a single five-point rating question. Patients were divided into two groups: 477 (83%) were completely satisfied and 96 (17%) were not completely satisfied. Multivariable logistic regression analysis was performed on preoperative and patient characteristics and recovery in five domains as follows: physiological, nociceptive (pain and nausea), emotive (anxiety and depression), activities of daily living and cognition. Recovery was defined as return to baseline values or better for all questions within each domain. Incomplete satisfaction was predicted by persistent pain or nausea at day 3 [OR 8.2 (95% CI 2.5 to 27), P<0.01] and incomplete satisfaction at day 1 [OR 28 (95% CI 10 to 77), P<0.01]. Paradoxically, incomplete satisfaction was less likely to occur if pain or nausea was present 15 min after surgery [OR 0.34 (95% CI 0.11 to 0.99), P<0.05] or at day 1 [OR 0.30 (95% CI 0.10 to 0.91), P=0.03]. Incomplete recovery in the other domains did not influence satisfaction. Of the recovery domains measured using the Postoperative Quality of Recovery Scale, only nociception (pain or nausea) contributed to incomplete satisfaction.

Preoperative Zung depression scale predicts patient satisfaction independent of the extent of improvement after revision lumbar surgery

Background contextPatient satisfaction ratings are increasingly being used in health care as a proxy for quality and are becoming the focal point for several quality improvement initiatives. Affective disorders, such as depression, have been shown to influence patient-reported outcomes and self-interpretation of health status. We hypothesize that patient psychiatric profiles influence reported satisfaction with care, independent of surgical effectiveness. PurposeTo assess the predictive value of preoperative depression on patient satisfaction after revision surgery for same-level recurrent stenosis. Study designRetrospective cohort study. Patient sampleFifty-three patients undergoing a revision surgery for symptomatic same-level recurrent stenosis. Outcome measuresPatient-reported outcome measures were assessed using an outcomes questionnaire that included questions on health state values (EuroQol-5D [EQ-5D]), disability (Oswestry Disability Index [ODI]), pain (visual analog scale [VAS]), depression (Zung self-rating depression scale), and Short Form 12 (SF-12) physical and mental component scores (PCS and MCS). Patient satisfaction was dichotomized as either “YES” or “NO” on whether they were satisfied with their surgical outcome 2 years after the surgery. MethodsA total of fifty-three patients undergoing revision neural decompression and instrumented fusion for same-level recurrent stenosis-associated back and leg pain were included in this study. Preoperative Zung self-rating depression score (ZDS), education status, comorbidities, and postoperative satisfaction with surgical care and outcome was assessed for all patients. Baseline and 2-year VAS for leg pain (VAS-LP), VAS for low back pain (VAS-BP), ODI, SF-12 PCS and MCS, and health-state utility (EQ-5D) were assessed. Factors associated with patient satisfaction after surgery were assessed via multivariate logistic regression analysis. ResultsTwo years after surgery, a significant improvement was reported in all outcome measures: VAS-BP (5±2.94 vs. 9.28±1, p<.001), VAS-LP (3.43±2.95 vs. 9.5±0.93, p<.001), ODI (21.75±12.07 vs. 36.01±6, p<.001), SF-12 PCS (32.30±11.01 vs. 25.13±5.84, p<.001), SF-12 MCS (47.48±10.96 vs. 34.91±12.77, p<.001), EQ-5D (0.60±0.31 vs. 0.18±0.22, p<.001), and ZDS (37.52±11.98 vs. 49.90±10.88, p<.001). Independent of postoperative improvement in pain and disability (surgical effectiveness), increasing preoperative Zung depression score was significantly associated with patient dissatisfaction 2 years after revision lumbar surgery (Odds ratio=0.67 [confidence interval: 0.38, 0.87], p<.001). ConclusionsOur study suggests that independent of the surgical effectiveness, the extent of preoperative depression influences the reported patient satisfaction after revision lumbar surgery. Quality improvement initiatives using patient satisfaction as a proxy for quality should account for the patients' baseline depression as potential confounders.

Hip Arthroscopy for FAI: Predictors of Patient Satisfaction and Conversion to Total Hip Arthroplasty 5 to 7 years Following Arthroscopy

Objectives:Hip arthroscopy is treatment method for patients with symptomatic femoroacetabular impingement (FAI). It is unclear what factors are associated with mid-term success. The purpose of this study is to report the clinical outcomes and the predictors of successful outcome at a minimum 5 years post-operatively.Methods:Between March 2005 and September 2006, 646 consecutive hip arthroscopies were performed. This study was IRB approved. Patients were included who underwent arthroscopic treatment of symptomatic FAI and chondrolabral dysfunction with radiographic and physical examination findings consistent with FAI. Exclusion criteria included patients < 18 years of age, professional athletes, labral reconstruction, Legg-Calve-Perthes disease, and those with underlying hip disease such as pigmented villonodular synovitis or synovial chondromatosis. All data were prospectively collected and retrospectively reviewed, including physical exam findings, radiographic measurements (alpha angle, the presence of a crossover sign or acetabular dysplasia, and joint space), re-operations or complications, and conversion to THA. Patients were evaluated pre- and post-operatively with a prospective subjective questionnaire. Primary outcome measure included the modified Harris Hip Score (MHHS), and secondary outcome measures included the Western Ontario and McMaster Universities Arthritis Index (WOMAC), Tegner activity scale, patient satisfaction, and conversion to THA.Results:Twenty-four patients were deceased or refused to participate at follow-up, and 284 patients(293 hips) met the inclusion criteria. The average age was 42 years(range, 18 to 77) and there were 140 females and 144 males. Sixty-eight hips (68 patients) required a total hip arthroplasty (THA) (24%). The average age of the THA group was 52 years (range, 32 to 77), with 60 patients (88%) over 40 years of age at the time of arthroscopy. There were 22 females (32%) and 46 males (68%). The average time to THA was 34.6 months post-operatively (range, 7 months to 5 years) and the average pre-operative MHHS was 58 (range, 24 to 100). Of the remaining 216 patients (225 hips), 171 patients (79%, or 178 hips) were available for follow up at a minimum of 5 years. The average follow-up was 6.6 years (range, 5 to 7.2). The MHHS improved from 61 to 80(p<0.001). The average WOMAC at follow-up was 9.0 and the median Tegner activity scale was 4.0. The median patient satisfaction with outcome was 9 (range, 1 to 10). There was no difference in the MHHS between patients who underwent labral debridement or labral repair(p=0.1). The significant multivariate predictors of increased post-operative patient satisfaction at follow-up were higher modified Harris Hip Scores (p=0.003) and not having a microfracture performed(p=0.015)(r2=0.2). Logistic regression modeling identified 2mm or less of joint space (P<0.0001, odds ratio=11.7, 95% CI: 3.6 to 38.1), hip requiring microfracure (o<0.0001, odds ratio=8.6, 95% CI:30. to 26.6) and age at surgery (p<0.0001) as significant independent, multivariate risk factors for conversion to THA.Conclusion:Hip arthroscopy for FAI and chondrolabral dysfunction results in a significant improvement in outcome measures with high patient satisfaction. Predictors of conversion to THA were age, 2mm or less of joint space, and having a microfracture. These results are from early generation hip arthroscopies and these predictors may be managed differently in current practice.

Three Keys to Patient Satisfaction: Nursing, Nursing, and Nursing

The title of this article might at first seem like a bit of an exaggeration, and indeed it is, but no more so than the time-honored real estate mantra: location, location, location. Those in the real estate business have learned firsthand that although other factors have some influence on consumer preference, in the end, they pale in comparison with the impact of one factor in particular—property location. Similarly, those with first-hand experience in the field of healthcare realize that there are a host of factors that play a role in determining patient satisfaction; however, when all is said and done, it is the influence of nursing services that has by far the most significant impact. Most staff nurses have a general understanding of this importance, but many have a less than full appreciation of just how strong it is. Even more importantly, hospital boards, medical staffs, senior management, and nursing leadership need to have a clear understanding of this relationship since there is now ample evidence that as staff nurse job satisfaction goes, so goes patient satisfaction. This important association has proven to be direct, pervasive, and consistent over time. 1 Kutney-Lee A McHugh MD Sloane DM et al. Nursing: a key to patient satisfaction. Health Aff (Millwood). 2009; 28: 669-677 Crossref PubMed Scopus (258) Google Scholar , 2 Larrabee JH Ostrow CL Withrow ML Janney MA Hobbs Jr., GR Burant C Predictors of patient satisfaction with inpatient hospital nursing care. Res Nurs Health. 2004; 27: 254-268 Crossref PubMed Scopus (119) Google Scholar The title of this article might at first seem like a bit of an exaggeration, and indeed it is, but no more so than the time-honored real estate mantra: location, location, location. Those in the real estate business have learned firsthand that although other factors have some influence on consumer preference, in the end, they pale in comparison with the impact of one factor in particular—property location. Similarly, those with first-hand experience in the field of healthcare realize that there are a host of factors that play a role in determining patient satisfaction; however, when all is said and done, it is the influence of nursing services that has by far the most significant impact. Most staff nurses have a general understanding of this importance, but many have a less than full appreciation of just how strong it is. Even more importantly, hospital boards, medical staffs, senior management, and nursing leadership need to have a clear understanding of this relationship since there is now ample evidence that as staff nurse job satisfaction goes, so goes patient satisfaction. This important association has proven to be direct, pervasive, and consistent over time. 1 Kutney-Lee A McHugh MD Sloane DM et al. Nursing: a key to patient satisfaction. Health Aff (Millwood). 2009; 28: 669-677 Crossref PubMed Scopus (258) Google Scholar , 2 Larrabee JH Ostrow CL Withrow ML Janney MA Hobbs Jr., GR Burant C Predictors of patient satisfaction with inpatient hospital nursing care. Res Nurs Health. 2004; 27: 254-268 Crossref PubMed Scopus (119) Google Scholar

Predicting the impact of hospital health information technology adoption on patient satisfaction

To develop and explore the predictability of patient perceptions of satisfaction through the hospital adoption of health information technology (HIT), leading to a better understanding of the benefits of increased HIT investment. The solution proposed is based on comparing the predictive capability of artificial neural networks (ANNs) with the adaptive neuro-fuzzy inference system (ANFIS). The latter integrates artificial neural networks and fuzzy logic and can handle certain complex problems that include fuzziness in human perception, and non-normal and non-linear data. Secondary data from two surveys were combined to develop the model. Hospital HIT adoption capability and use indicators in the Canadian province of Ontario were used as inputs, while patient satisfaction indicators of healthcare services in acute hospitals were used as outputs. Eight different types of models were trained and tested for each of four patient satisfaction dimensions. The accuracy of each predictive model was evaluated through statistical performance measures, including root mean square error (RMSE), and adjusted coefficient of determination R(2)(Adjusted). For all four patient satisfaction indicators, the performance of ANFIS was found to be more effective (R(Adjusted)(2)=0.99) when compared with the results of ANN modeling in predicting the impact of HIT adoption on patient satisfaction (R(Adjusted)(2)=0.86-0.88). The impact of HIT adoption on patient satisfaction was obtained for different HIT adoption scenarios using ANFIS simulations. The results through simulation scenarios revealed that full implementation of HIT in hospitals can lead to significant improvement in patient satisfaction. We conclude that the proposed ANFIS modeling technique can be used as a decision support mechanism to assist government and policy makers in predicting patient satisfaction resulting from the implementation of HIT in hospitals.

Determinants of patient satisfaction with outpatient health services at public and private hospitals in Addis Ababa, Ethiopia

BackgroundPatients have explicit desires or requests for services when they visit hospitals. However, inadequate discovery of their needs may result in patient dissatisfaction. This study aimed to determine the levels and determinants of patient satisfaction with outpatient health services provided at public and private hospitals in Addis Ababa, Central Ethiopia.MethodsA comparative cross-sectional study was conducted from 27 March to 30 April 2010. The study included 5 private and 5 public hospitals. Participants were selected using systematic random sampling. A pre-tested and contextually prepared structured questionnaire was used to conduct interviews. Descriptive statistics, analysis of variance, factor analysis and multiple linear regressions were performed using computer software (SPSS 16.0).ResultsAbout 18.0% of the patients at the public hospitals were very satisfied whilst 47.9% were just satisfied with the corresponding proportions a bit higher at private hospitals. Self-judged health status, expectation about the services, perceived adequacy of consultation duration, perceived providers’ technical competency, perceived welcoming approach and perceived body signalling were determinants of satisfaction at both public and private hospitals.ConclusionsAlthough patients at the private hospitals were more satisfied than those at the public hospitals with the health care they received, five of the predictors of patient satisfaction in this study were common to both settings. Thus, hospitals in both categories should work to improve the competencies of their employees, particularly health professionals, to win the interests of the clients and have a physical structure that better fits the expectations of the patients.

Satisfaction with orthodontic treatment.

Abstract Objectives: To examine the satisfaction of patients with their orthodontic treatment at the Department of Orthodontics at the Academic Centre for Dentistry Amsterdam (ACTA) in the Netherlands. Materials and Methods: To analyze differences in satisfaction through time, the results of patients treated at ACTA in 2008 and 2009 were compared with the results of patients treated at ACTA in 2000. A validated questionnaire about patient satisfaction was used. The total scale was divided into six subscales. A questionnaire was sent to all patients younger than 30years who finished orthodontic treatment in 2008 and 2009 at ACTA. Results: The internal consistency of the total scale and the six subscales of the questionnaire was satisfactory. Respondents scored highest on items about satisfaction with the doctor-patient relationship (mean, 4.24; SD, 0.63) and lowest on items regarding their satisfaction with psychosocial improvement (mean, 2.88; SD, 0.87). In contrast to the sample from 2000, gender was no significant predictor of patient satisfaction. The results showed significantly lower values on overall satisfaction and on all subscales, with only one exception. On the subscale psychosocial improvement, females in the present study had similar scores to females in 2000. Conclusions: The doctor-patient relationship remains the most important factor contributing to patient satisfaction. However, the results show that, overall, patients are less satisfied with their orthodontic treatment than patients were a decade ago and that gender differences no longer predict patient satisfaction.

Assessing patients for joint replacement: can pre-operative Oxford hip and knee scores be used to predict patient satisfaction following joint replacement surgery and to guide patient selection?

Assessing patients for joint replacement: can pre-operative Oxford hip and knee scores be used to predict patient satisfaction following joint replacement surgery and to guide patient selection?

Predictors of patient satisfaction with Mohs surgery: analysis of preoperative, intraoperative, and postoperative factors in a prospective cohort.

To identify preoperative, intraoperative, and postoperative variables that predict higher short- and long-term patient satisfaction with Mohs surgery. Prospective cohort study. A university-based dermatology practice and the affiliated Veterans Affairs medical center dermatology clinic. A total of 339 consecutive patients treated with Mohs surgery in 1999 and 2000. Short-term satisfaction at 1 week and long-term satisfaction at 1 year. We used directed acyclic graphs to determine appropriate confounding adjustment for preoperative, intraoperative, and postoperative variables that influence satisfaction with Mohs surgery in logistic regression models. Better preoperative skin-related quality of life (measured using Skindex) and more intraoperative Mohs stages were the most salient predictors of higher short- and long-term satisfaction; these odds ratios (ORs) were 2.33 (95% CI, 1.01-5.35) and 5.19 (1.66-16.29), respectively, for preoperative skin-related quality of life and 7.06 (2.02-24.67) and 5.30 (1.24-22.64), respectively, for more intraoperative Mohs stages. Patients not bothered by postoperative bleeding were more likely to be satisfied short term (OR, 2.25; 95% CI, 1.25-4.05), as were those who considered themselves involved in decision making about their treatment (3.05; 1.52-6.10). Higher long-term satisfaction with Mohs surgery was observed among patients who were married (2.36; 1.10-5.09). Higher short- and long-term satisfaction with Mohs surgery is predicted by better preoperative skin-related quality of life and by more intraoperative Mohs stages. The effect of postoperative variables wanes over time, suggesting that factors influencing satisfaction can vary depending on the time frame when satisfaction is measured. Our results may help clinicians identify patients who are at higher risk of dissatisfaction following Mohs surgery.